MEDICARE: DR. CLINTON DOUGLAS HOLDER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	40558	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	440003237	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME0040558	OTHER	FL	WORKERS' COMPENSATION
2	9205221	OTHER	FL	UNITEDHEALTHCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	5600211	OTHER	FL	GHI
5	30588	OTHER	FL	BLUE CROSS/BLUE SHIELD
7	923014	OTHER	PA	BLUE CROSS/BLUE SHIELD
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578560777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CLINTON DOUGLAS HOLDER M.D.

Provider Business Mailing Address
First Line	:	4604 29TH ST E
Second Line	:
City	:	PALMETTO
State	:	FL
Zip	:	34221-9793
Country	:	US
Telephone Number	:	941-845-4572
Fax Number	:	941-845-4572

Provider Business Practice Location Address
First Line	:	4604 29TH ST E
Second Line	:
City	:	PALMETTO
State	:	FL
Zip	:	34221-9793
Country	:	US
Telephone Number	:	941-845-4572
Fax Number	:	941-845-4572

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	03/07/2023

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